During this past year Cesar consulted with Nephrologist Dr. Bhatla X 4 for Hyponatremia, whom throughout the visits recommended to continue with fluid restriction, add Sodium Chloride 1 gram tab BID, limit salt to 2 gram per day as well as monitoring labs (uric acid, sodium, BMP) and a Renal Ultrasound which revealed right kidney with normal limits and the missing kidney. -Endocrinologist Dr. Cepeda X 3 for evaluation and management of hyponatremia; Dr. Cepeda indicated that differential diagnosis included SIADH due to anti-seizure medications (Keppra and Lamictal), recommendations to recheck CMP, urine sodium and serum osmolality, cortisol and cosyntropin stim test to rule out adrenal insufficiency. Cosyntropin test was completed at DHR hospital …show more content…
Narro for Seizures and Hyponatremia; Dr. Narro recommended to decreased Keppra and a CT scan of brain w/o contrast that was completed on 5/8/17, Impression with No acute intracranial bleed is seen and Atrophy with white matter changes. Keppra was discontinued on 7/21/17. During the last consult it was recommended to continue with Lamictal for now. -Gastroenterologist Dr. Green X 2 for vomiting, EGD and upper GI series. EGD was completed at VBMC in 10/4/17, recommendation for Omeprazole 40 mg PO BID, high fiber diet, and anti-reflux measures; diagnosis of Small Hiatal hernia, Gastritis. Pathology report indicated “increased chronic inflammation to include occassional eosinophils -No Squasmous epithelium present -No Ulcer, ativity, Dysplasia or Malignancy -IHC stain for Helicobacter pylori is negative. -Urology Dr. Espinoza X 2 for evaluation and management of acute prostatitis with obstructive symptoms. Dr. Espinoza recommended to add Avodart 0.5 mg CAP PO daily on 1/9/17. During the last urology consult it was recommended to continue with Flomax, Avodart and to follow up in 1 year. -Vision X 2 for suspected Glaucoma and IOP check. Dr. Grannum indicated that clients Glaucoma was stable, continue with Latanoprost 1 gtt. QHS OD and observe; next visit in 4 months for IOP …show more content…
Rowin evaluation revealed Chronic stable mastoiditis, Hearing loss, and Ear drainage; recommended to start cortisporin otic 3 gtts AU TID and follow up in 6 months. -Dental X 3 with Dr. Jackson; Cesar underwent dental rehabilitation UGA for annual dental exam at VBMC in the outpatient setting that revealed caries, generalized moderate chronic adult periodontal disease, negative cancer screen, heavy plaque and calculus, moderate gingival inflammation, bone loss, 9 missing teeth, tooth decay, poor tissues and oral hygiene, no evidence of osteonecrosis. Follow up consult s/p dental rehab with indications of satisfactory healing, good occlusion and minimal gingival
HPI: MR is a 70 y.o. male patient who presents to ER with constant, dull and RUQ abdominal pain onset yesterday that irradiate to the back of right shoulder. Client also c/o nauseas, vomiting and black stool x2 this morning. He reports that currently resides in an ALF; they called the ambulance after his second episodes of black stool. Pt reports he drank Pepto-Bismol yesterday evening without relief. Pt states that he never experienced similar symptoms in the past. Denies any CP, emesis, hematochezia or any other associated symptoms at this time. Client was found with past history gallbladder problems years ago.
Frank has returned six weeks since the last appointment. A couple of weeks following that review, Frank underwent repeat pathology that revealed renal impairment with an EGFR of 54. I subsequently arranged a renal tract ultrasound, urinalysis and encourage increased oral hydration and repeated his electrolytes. Pleasingly his renal function improved with a repeat EGFR of 87 and the other investigations were unremarkable. Frank subsequently the micophenylate dose to 1gm bd.
Lisinopril can cause symptomatic hypotension, and sometimes it can be complicated by oliguria, progressive azotemia, or acute renal failure. Patient at risk for hypotension should be careful about this medicine and should be started under the close medical supervision and should be followed closely during the first two week of treatment and whenever there is a dose increase. During the treatment, potassium level should be monitored as it can cause hyperkalemia. Patient can develop hepatic failure, therefore patient who develop jaundice or marked hepatic enzyme elevations should immediately discontinue the medicine. Lisinopril can cause angioedema and patient need to be educated about this. Impaired renal function is possible, therefore patient taking Lisinopril need to monitor their renal function periodically. The effectiveness of the treatment can be monitored thorough the monitoring of the blood pressure (Kaufman,
When diagnosed with hyponatremia treatment usually immediately begins. Treatment must be a restriction of both salt and water (Gheorghita et. al 2010). Hyponatremic patients must receive a slow increase in sodium with a restriction of liquids. Intravenous hypertonic saline solution of 3% NaCl can be administered to patients who have been diagnosed with hyponatremia. There is a precise formula that is used in determining the quantity of NaCl that is used in increasing sodemia and the rate at which it should be administered (Gheorghita et. al 2010).
...atment option your doctor suggests, careful monitoring and follow-up visits are required to successfully combat the symptoms.
Currently there are two types of renal replacement therapy. The original dialysis which we called it hemodialysis used for patients with chronic renal failure, needs the patients to come to hospital 2-3 times per week. This type of dialysis called the intermittent hemodialysis .However the intermittent hemodialysis is difficult to do it in the intensive care population with acute renal failure because of the hemodynamic instability and those type of patients usually are the most sick and critically ill patients within the intensive care units and have multiorgan dysfunctions, so medically is too difficult to do for them intermittent hemodialysis. In addition intermittent hemodialysis will increase the mortality and morbidity among them. Within the modern intensive care units new way of dialysis has been developed 30 years ago called continuous renal replacement therapy (CRRT).The definition of (CRRT) is any extracorporeal blood purification therapy intended to substitute for impaired renal function over an extended period of time and applied for or aimed at being applied for 24 hours/day, Bellomo R., Ronco., Mehata R. The CRRT was found because the traditional way of ...
When asked about his typical elimination pattern, the patient stated that he voids several times daily, and typically has one bowel movement per day. The patient denied any concerns nor expressed any problems regarding his usual pattern of bowel/bladder elimination. He also denied any symptoms such as pain, bleed, unusual appearance or pattern. Furthermore, he has previously experienced dysuria and hesitancy by record. No treatment regarding elimination is implied at this time. There were no labs drawn in respects to the patient’s fluid or electrolyte status.
Based on the radiographs that were previously taken by another student, the patient has areas of decay and generalized bone loss. These findings indicate that individualized home care is crucial in the progression of the treatment plan. The ten page assessment findings included areas of active decay, bulbous and shiny gingiva, and occlusal wear on the anterior teeth. A night guard is important to recommend in order to help to prevent further wear on the occlusal surface. The generalized areas of decay within the mouth indicate that this patient is in need of nutritional counseling. Nutritional counseling is helpful in determining the food items and beverages that the patient's eats and drinks that are high in sugar or carbohydrates. Nutritional counseling for my patient revealed that my patient drinks multiple different types of juices due to being unaware of the amount of sugar contained in
Note: This response sheet is for educational purposes only and should not be taken as a clinical diagnosis. Results need to be confirmed by professionals qualified in your state/province.
Over time as individuals age and are faced with access to care issues they may begin to neglect their oral health. As time passes between dental hygiene cleanings or dentist visits the presence of oral disease may begin to increase.
Addisonian crisis, they have severe pain in the abdomen, back, and legs. Vomiting, diarrhea, or
In addition to the complete blood count the doctor had also ordered new electrolytes to be drawn up that day. Electrolytes are ions that are present in the human body and require a particular balance in order for cells to function normally (Pagana & Pagana, 2010). The electrolytes the doctor ordered included, sodium, potassium, chloride, calcium, phosphate and magnesium (Pagana & Pagana, 2010). From these findings only sodium, an electrolyte involved in fluid regulation, pH balance and muscle contractions was found to be elevated (Pagana & Pagana, 2010). At five days post-op her sodium level was mildly high at 148mmol/l and on the date of my care it was 150mmol/l, higher than the normal of 137-145mmol/l.
P…* FIV tested +; *hospitalization for observation; *200 ml Normasol fluids SQ then *iv fluids @150ml/hr, 3 ml vit B complex added; urinalysis to be performed in a.m. after completion of fluid therapy.
However, on the a recent visit dated 23/12/13 the patient’s gingival condition had deteriorated, presenting with an increased plaque scores of 34% and bleeding scores to 63%. Intra oral examination also showed generalised oedema and erythema throughout in the mouth in response to this increase in plaque bacteria. The presence of supra-gingival calculus on lower anterior teeth and both sites of upper buccal molars and the patients BPE now reads 212 /121, putting the patients caries risk at a ‘High’ status.
The purpose of this paper is to take an in depth look at a renal diet which is designed for people suffering from certain kidney conditions. A renal diet can be described as a nutritional regime which is: “low in sodium, phosphorous and protein... [It] also promotes the importance of consuming high-quality protein and usually limits fluids. Some patients may also need to limit potassium and even calcium” (Nephcure). Throughout the course of this paper various aspects are addressed. these include: the role of the kidneys, the importance of professional guidance, the reasons why people follow a renal diet, monitoring sodium intake, monitoring potassium intake, monitoring phosphorus intake, protein consumption, and fluid control.